CPT 97763 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | • 11 - Office • None |
| Common Modifiers | • GO - Services delivered under an outpatient occupational therapy plan of care • None • KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
National average reimbursement for CPT 97763 by major payers:
$63.59
$53.97
$65.37
$66.63
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 97763 | ||||||
United | 97763 | $53.88 | 1295901841 - ANNA BOVEE | 911939739 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $49.22 | 1730655820 - TAMARA MULLINS | 753175249 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $27.00 | 1275997983 - BENCHMARK PHYSICAL THERAPY OF OREGON LLC | 300914919 | OR | Physical Therapist (225100000X) |
United | 97763 | $49.22 | 1255043782 - CHELSEY PAULS | 205885848 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $75.77 | 1891103743 - TARA WENDLANDT | 562620819 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $49.08 | 1730796525 - EDEN FAIR | 272006180 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $54.13 | 1215566922 - SARAH FIHN | 330633863 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $53.88 | 1528243185 - MAGGIE CONSER | 262998718 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $54.13 | 1891223848 - ROXANNA STEPHENS | 930505325 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $53.88 | 1619709441 - JOY GUMMOW | 930281321 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $54.13 | 1942812771 - CHRISTINE DOTSON | 930505011 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $161.69 | 1306457767 - CECILEA HOERING | 237366812 | OR | Family Nurse Practitioner (363LF0000X) |
United | 97763 | $54.13 | 1770101776 - TAYLOR ECKEL | 931206728 | OR | Physical Therapist (225100000X) |
United | 97763 | $54.13 | 1942502794 - INTEGRATED JOINT SPECIALISTS LLC | 273312107 | OR | General Practice Physician (208D00000X) |
United | 97763 | $165.80 | 1669786661 - YURIKO LEE | 931097258 | OR | Family Nurse Practitioner (363LF0000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 97763 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97763 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97763 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97545-CPT | Low | Work Hardening/Condit Initial 2 Hrs |
| 97546-CPT | Low | Work Hardening/Conditioning; Each Additional Hour (List Separately In Addition To Code For Primary Procedure) |
| 97760-CPT | Low | Orthotic(S) Management And Training (Including Assessment And Fitting When Not Otherwise Reported) Upper Extremity(Ies) Lower Extremity(Ies) And/Or Trunk Initial Orthotic Encounter Each 15 Minutes (Desc Revised 1/1/2018) |
| 97763-CPT | Low | Orthotic(S)/Prosthetic(S) Management And/Or Training Upper Extremity(Ies) Lower Extremity(Ies) And/Or Trunk Subsequent Orthotic(S)/Prosthetic(S) Encounter Each 15 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97763. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97763 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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